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Amitriptyline

This guide takes you through the different types of medications that may be prescribed following your consultation with the LBSM physicians.

If you have any further questions or are unsure about the medication you have been prescribed, please do not hesitate to contact us.

Amitriptyline for pain and migraine

Key facts

  • It’s best to take your amitriptyline in the evening or before you go to bed. This is because it can make you feel sleepy.
  • You may start to feel better after 1 or 2 weeks, but it can take 6 weeks for amitriptyline to work as a painkiller.
  • Amitriptyline can cause extra side effects if you stop taking it suddenly. Talk to your doctor if you want to stop taking it.
  • Amitriptyline is also used to treat depression, but at lower doses it’s very good for treating pain.

Summary

  1. About amitriptyline for pain and migraine
  2. When should I see improvements in my pain
  3. How long will I need to take Amitriptyline for
  4. What happens when I stop taking Amitriptyline
  5. Who can and cannot take amitriptyline
  6. How and when to take amitriptyline
  7. What are the side effects
  8. Amitriptyline and pregnancy
  9. Cautions with other medicines and substances

About Amitriptyline for pain and migraine

Amitriptyline is a medicine used for treating pain. You can take it:

  • to treat nerve pain (neuralgia) and back pain 
  • to help prevent migraine attacks 

Amitriptyline is available on prescription. It comes as tablets and as a liquid that you drink.  

Amitriptyline is from a group of medicines called tricyclic antidepressants and can be used to treat low mood.  

They are thought to work by increasing a chemical called serotonin in your brain. This can improve your mood. 

This can also change the way that your nerves receive pain signals so pain goes away. This helps your symptoms if you are taking amitriptyline for nerve related pain pain (e.g. sciatica) relief or migraine. 

When should I see improvements in my pain 

You may find you are sleeping better straight away. But it usually takes 1 or 2 weeks for pain to begin to wear off. 

It can take between 4 and 6 weeks before you feel the full benefits of amitriptyline as a painkiller. 

Do not stop taking amitriptyline after 1 to 2 weeks just because you feel it’s not helping your symptoms. Give it at least 6 weeks to work. 

Although amitriptyline is an antidepressant, the doses are lower to help pain. Taking amitriptyline as a painkiller will not change your personality or make you feel any different. 

How long will I need to take Amitriptyline for 

Once you’re feeling better you’ll probably continue to take amitriptyline for as long as it’s working for you as a painkiller or to help prevent migraines. 

Some people take it for many months and even for years. 

Amitriptyline is safe to take for a long time. There do not seem to be any lasting harmful effects from taking it for many months or years. 

Amitriptyline is not addictive but you can get extra side effects if you stop taking it suddenly. You may have flu-like symptoms like feeling sick, muscle pain and feeling tired or restless. 

To help prevent this happening, your doctor will probably recommend reducing your dose gradually over several weeks – or longer, if you have been taking amitriptyline for a long time. 

What happens when I stop taking Amitriptyline 

You may get extra side effects when you stop taking amitriptyline, especially if you stop taking it suddenly. 

These side effects are a physical reaction as the medicine leaves your system. You may get flu-like symptoms like feeling sick, muscle pain and feeling tired or restless. 

To help prevent them, your doctor will probably recommend reducing your dose gradually over several weeks – or longer, if you have been taking amitriptyline for a long time. 

Who can and cannot take amitriptyline 

Most adults (aged 18 and over) can take amitriptyline. Children aged 2 years and older can take it for some types of nerve pain. 

Amitriptyline is not suitable for some people. Check with your doctor before starting to take amitriptyline if you: 

  • have ever had an allergic reaction to amitriptyline or any other medicine 
  • have a heart problem – amitriptyline can make some heart problems worse 
  • have a rare blood disorder called porphyria 
  • have liver or kidney problems 
  • have epilepsy – amitriptyline can increase seizures or fits 
  • have ever taken any medicines for depression – some antidepressants used rarely can affect the way amitriptyline works 
  • are pregnant, trying to become pregnant, or breastfeeding 
  • have an eye problem called glaucoma – amitriptyline can increase the pressure in your eye 
  • have thoughts about harming yourself or ending your life 
  • have type 1 or type 2 diabetes 

If you have diabetes, amitriptyline may change your blood sugar level. If you usually test your blood sugar levels, you may have to do this more often for the first few weeks of treatment. Talk to your diabetes doctor if the reading goes too high or low. 

How and when to take amitriptyline 

It’s usual to take amitriptyline once a day. It’s best to take it before bedtime because it can make you feel sleepy. If you find that you are still feeling drowsy in the morning you could try taking it earlier in the evening. 

This medicine does not usually upset your stomach. You can take it with or without food. 

Swallow the tablets whole, with a drink of water. If you chew them, they taste bitter. 

The liquid comes with a plastic syringe or spoon to help you measure out the right dose. If you don’t have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount. 

Dosage

Amitriptyline tablets come in 3 different strengths – 10mg, 25mg or 50mg.

The liquid also comes in 3 different strengths – containing 10mg, 25mg or 50mg of amitriptyline in a 5ml spoonful.

The usual starting dose for adults and older children (aged 12 to 17 years) is 10mg a day. This dose can be increased by your doctor if you need better pain relief.

The starting dose for younger children depends on their weight and symptoms. The doctor will tell you how much to give them.

The maximum dose of amitriptyline for treating pain is 75mg a day. Your doctor may give you a higher dose if you’re taking it to prevent migraine.

What if I forget to take it?

If you forget to take your amitriptyline, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just leave out the missed dose and take your next one as normal.

If amitriptyline usually makes you sleepy and you need to drive, cycle or use tools or machinery, skip the missed dose and then take the next dose as normal.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What are the side effects 

Like all medicines, amitriptyline can cause side effects in some people, but many people have no side effects or only minor ones. 

Some of the common side effects of amitriptyline gradually improve as your body gets used to the medicine. 

Common side effects 

Doses of amitriptyline for pain are lower than the doses for depression. This means the common side effects tend to be milder and go away within a few days. 

Keep taking the medicine but talk to your doctor or pharmacist if these side effects bother you or do not go away: 

  • constipation 
  • dizziness 
  • dry mouth 
  • feeling sleepy (affecting ability to drive) 
  • difficulty peeing 
  • Headache 
  • Change in appetite with weight change 

Do not drive a car or ride a bike if amitriptyline makes you sleepy, gives you blurred vision or makes you feel dizzy, clumsy or unable to concentrate or make decisions. This may be more likely when you first start taking amitriptyline but it could happen at any time, for example when starting another medicine. 

Serious side effects 

It happens rarely, but some people have a serious side effect after taking amitriptyline. 

Call a doctor straight away if you have: 

  • a fast or irregular heartbeat 
  • yellow skin, or the whites of your eyes go yellow – these can be signs of a liver problem 
  • a headache, feel confused or weak, or get muscle cramps – these can be signs of a low sodium level in your blood 
  • thoughts about harming yourself or ending your life 
  • eye pain, a change in your eyesight, swelling or redness in or around your eye 

Immediate action required:Call 999 or go to A&E if: 

you have weakness on one side of your body, trouble speaking or thinking, loss of balance or blurred eyesight – these can be signs of a stroke 

How to cope with side effects of amitriptyline 

What to do about: 

  • constipation – eat more high-fibre foods such as fresh fruit and vegetables and cereals. Try to drink several glasses of water or other non-alcoholic drinks every day. If you can, it may also help to do some exercise. 
  • dizziness – this is probably due to low blood pressure. Drink plenty of water or other non-alcoholic drinks. Do not stand up too quickly after you have been sitting or lying down. 
  • dry mouth – try sugar-free gum or sugar-free sweets. 
  • feeling sleepy or tired – take amitriptyline in the evening and cut down on the amount of alcohol you drink. Do not drive, cycle or use tools or machinery if you’re feeling this way. 
  • difficulty peeing – relax when you try to pee. Do not try to force the flow of urine. If you still cannot go, try again later. Talk to your doctor urgently if you cannot pee at all. 
  • headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Try taking paracetamol or ibuprofen if you need pain relief. Talk to your doctor if the headaches last longer than a week or are severe. 

Amitriptyline with pregnancy and breastfeeding 

Amitriptyline is generally not recommended in pregnancy. This is because it has been linked to a small risk of problems for your baby if you take it in early or late pregnancy. 

Talk to your doctor as there may be other painkillers you can take instead of amitriptyline. Paracetamol is usually the first choice of painkiller if you’re pregnant or breastfeeding. 

Your doctor will only prescribe amitriptyline for your pain while you’re pregnant if the benefits of taking the medicine outweigh the risks. 

Amitriptyline is not usually recommended if you’re breastfeeding. 

Amitriptyline gets into breast milk. It’s been linked with side effects like sleepiness in breastfed babies. 

Talk to your doctor if you want to breastfeed. There may be other medicines that you can take instead of amitriptyline. 

Non-urgent advice:Tell your doctor if you’re: 

  • trying to get pregnant 
  • pregnant 
  • breastfeeding 

Cautions with other medicines and substances 

You are allowed to drink alcohol whilst taking amitriptyline but it may make you sleepy. It is also recommended to drink safely and sensibly.  

Many medicines and amitriptyline can affect each other and increase the chances of side effects. 

Always check with your doctor or a pharmacist before starting any new medicine while you are taking amitriptyline. 

Taking opioid-based medicines, like codeine, morphine or oxycodone, together with amitriptyline can increase your risk of becoming very drowsy and having breathing problems. 

Tell your doctor if you have ever taken any medicines for depression. Some antidepressants can affect the way amitriptyline works to cause very high blood pressure. This can happen even after you have stopped taking them. 

Do not take St John’s wort, a herbal remedy often taken for depression, while you are being treated with amitriptyline. It will increase your risk of side effects. 

There’s very little information about taking amitriptyline with other herbal remedies and supplements. They are not tested in the same way as medicines. 

Please feel free to contact us if you have any queries about your medication. Look forward to seeing you at your next appointment.  

Wishing you a speedy recovery 

The LBSM team. 

The information in this article has been cited from www.nhs.uk to align with best clinical practice standards.

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